The present invention concerns an immunological process for the determination of prostate-specific antigen (PSA), in particular for the determination of free PSA, the total PSA level and the concentration of PSA-serpin complexes by incubation of the sample with at least one antibody specifically binding to free PSA but not binding to complex PSA. The process is characterized in that a nucleophile containing amine is added to the sample before the determination of the total PSA concentration. Furthermore, the invention concerns the use of amine-containing nucleophiles for the production of free PSA as well as a process for preparing free PSA from complex PSA by incubation of a sample containing complex PSA with an amine-containing nucleophile.
The prostate-specific antigen is a glycoprotein with a molecular weight of 29 kDa. It is built in the epithelial prostate cells and is a component of the seminal fluid. PSA has the enzymatic activity of a neutral serine protease.
The main function of PSA is the cleavage of the seminogelines I and II as well as of fibronectin whichxe2x80x94as essential ejaculation componentsxe2x80x94block the sperm mobility. By the hydrolysis of these proteins PSA liquefies the semen coagulum and thus enables the sperm mobility.
The enzymatically active PSA is inactivated in the serum by various inhibitors. The so-called serpins (=serine protease inhibitors) belong to the most important inhibitors which inactivate PSA by forming covalent complexes. The main amount (60-95%) of the immunologically detectable PSA is bound in the serum to xcex11-antichymotrypsin (=ACT), which belongs to the serpins.
Further complexes can be formed with xcex11-antitrypsin and protein C inhibitor which are, however, in comparison to PSA-ACT, only of secondary importance in the serum.
In addition, PSA also forms a complex with a different type of protease inhibitor, i.e. the xcex12-macroglobulin (xcex12-M). Information on the complex concentration in the serum are different in the literature which is particularly due to the immunological inaccessibility of the PSA in this complex. The serum also contains enzymatically inactive free PSA which cannot form complexes. In the following xe2x80x9ctotal PSAxe2x80x9d means the sum of free PSA and serpin-complex PSA since the PSA complex with xcex12-M is not registered in any immunological determination performed until now. (Teware and Bluestein, J. Clin. Ligand Assay 1995, vol. 18, p. 186-196).
xcex11-antichymotrypsin is a glycoprotein with a molecular weight of approx. 60 kDa. As one of the main inhibitors in the acute phase ACT plays an important role in the control of inflammation. ACT also forms complexes with chymotrypsin, cathepsin G and glandular callicrein hK2. In human serum the molar ACT concentration is 10,000 times higher than that of PSA.
Due to the occurrence of different PSA forms the conditions for determination of the PSA concentration in human sera for the diagnosis of a prostate carcinoma or a benign disease are very complex. This fact evokes a number of diagnostic difficulties and reduces the value of this marker to a certain extent. Thus, it is known that some of the available assays for the determination of PSA give different values of free and complex PSA due to the specificity of the antibodies used thou et al., Clin. Chem. 1993, Vol. 39/12, p. 2483-2491; McCormack et al., Urology 1995, Vol. 45, p. 729-744; Tewari and Williams, Clin. Chem. 1998, Vol. 44, p. 191-192; Blase and Sokoloff, Clin. Chem. 1998, Vol. 44, p.192-193). In addition, an exact and uniform standardization is difficult because of the occurrence of the different forms mentioned (Chen et al., Clin. Chem. 1995, Vol. 41, p. 1273-1282).
The reliability of the PSA serum values as an indicator of a prostate carcinoma (PCa) up to a concentration of approx. 15 ng/ml is particularly problematic since such concentrations of total PSA can also result from the occurrence of a benign prostate hyperplasia (BPH). A prostate carcinoma screening by simple determination of the PSA value in the serum is not possible due to the lacking specificity in this concentration range; further investigations which are partly complex and painful (biopsy) must be performed to find out whether a PCa has occurred or not.
During the last years the determination of the ratio of free, i.e. uncomplexed PSA to complexed PSA or total PSA could improve the specificity to a certain extent (see e.g. WO 92/01936). It is, however, still clearly below a specificity value which would be necessary to avoid a larger number of unnecessary and time-/cost-intensive further examinations. The improvement of the specificity is based on the fact that in sera of patients with BPH the average ratio of free to complex PSA (PSAfree/PSAtotal) is higher than in sera of PCa patients.
For state of the art establishment of the PSAfree/PSAtotal ratio two different measurings must be performed. First of all the concentration of free PSA must be determined. If this test for free PSA is carried out in the sandwich format at least one of the two antibodies must be specific for free PSA and must not bind to complex PSA. Simultaneously, the total PSA concentration must be established in a second separate measurement. In this case the antibodies used in the sandwich test bind to free and complex PSA. Alternatively, the total concentration can also be determined by measuring the PSA-ACT concentration. In the WO 92/01936 such an antibody binding to free and complex PSA as well as an antibody specifically binding to ACT is used for the detection of the PSA-ACT concentration.
The total PSA amount can be achieved by adding the measuring value of the PSA-ACT complex and the measuring value of free PSA.
A big disadvantage of the state of the art process is that two different tests are performed which involve each at least two antibodies with a different specificity. The use of different reagents, e.g. antibodies, in several test procedures for the determination of a diagnostically relevant parameter very probably leads to problems when comparing tests of different manufacturers, particularly when such a complex diagnostic problem like that of PSA is regarded. In addition, the fault probability of the determination of reagents rises with the number of test systems used and reagents required. Furthermore, the provision of a large number of different, generally monoclonal antibodies is very cost- and time-intensive.
The task was therefore to develop an improved and simplified immunological process for the detection of PSA, in particular for the detection of free PSA, the total PSA concentration and the concentration of PSA-serpin complexes to overcome the state of the art disadvantages to a large extent.
The task is fulfilled with an improved immunological process for quantitative determination of PSA by incubation of the sample with at least one antibody binding specifically to free PSA but not to complex PSA, wherein an amine-containing nucleophile is added to the sample before the determination of the total PSA concentration. This procedure is preferably used for the quantitative determination of the concentration of free PSA, total PSA and of the PSA-serpin complexes.
The complex of PSA and serpins, in particular ACT, is stable and withstands drastic temperature and pH conditions (McCormack et al., Urology 1995, Vol. 45, p. 729-744). Surprisingly, it has been shown that the PSA-serpin complex can be cleaved by adding amine-containing nucleophilic reagents.
HPLC analyses have shown that the resulting PSA is stable. Surprisingly, this is also the case in the presence of serum, i.e. no new complexes are built. This can be recognized by the value of free PSA after the incubation under cleavage conditions which corresponds to the total PSA value before the cleavage. This result is surprising because free PSA in the serum actually should have been complexed again due to the very high excess of the protease inhibitors xcex11-antichymotrypsin and (xcex12-macroglobulin. This is at least the case when additional PSA is added to a human serum sample (Maim and Lilja, Scand. J. Clin. Invest. 1995 Vol.55, p. 15-22; Huber et al. The Prostate 1995, Vol. 27, p. 166-175).
Due to the practically irreversible cleavage of the PSA-serpin complex (in particular of the PSA-ACT complex) the possibility to determine the free PSA concentration in the untreated sample does exist. This is preferably carried out by a sandwich immunoassay where at least one of the antibodies specifically binds to free PSA but not to complex PSA. An amine-containing nucleophilic reagent is added to an identical parallel sample which leads to the cleavage of the serpin-complexed PSA (mainly PSA-ACT) and the release of the previously complexed PSA. Subsequently, the concentration of free PSA is determined in the same measuring procedure, i.e. by means of the same antibodies. The resulting value corresponds to the total PSA concentration. The synonyms xe2x80x9ctotal concentration of PSAxe2x80x9d, xe2x80x9ctotal PSAxe2x80x9d, xe2x80x9ctotal level of PSAxe2x80x9d and xe2x80x9cPSAtotalxe2x80x9d in the state of the art all mean the amount of free PSA and PSA complexed with serpins.
By dividing the concentration of free PSA by that of total PSA one obtains the informative ratio PSAfree/PSAtotal. By subtracting the value of PSAfree from PSAtotal the concentration of PSA complexed with serpins can also be determined and subsequently the ratio PSAfree/PSA serpin complex and PSAfree/PSA-ACT can be determined too.
With a certain degree of probability this ratio indicates the occurrence of a BPH or a PCa. The higher this ratio the higher is the probability of the occurrence of a benign disease.
An appropriate procedure of the process according to the invention for the determination of free PSA and of the total PSA concentration includes the following steps: a) Incubation of a part of the sample with at least one antibody specifically binding to free PSA but not to complex PSA, b) determination of the concentration of free PSA, c) incubation of a part of the sample with an amine-containing nucleophilic reagent, d) incubation of the sample from step c) with an antibody according to step a), e) determination of the total PSA concentration in the sample according to step b), and f) determination of the ratio: free PSA to total PSA concentration using the values from step b) and e).
If the ratio PSAfree/PSA-serpin complex and PSAfree/PSA-ACT is to be established the following has to be done: as step f) the concentration of free PSA from step b) is subtracted from the total PSA concentration and as step g) the ratio of free PSA according to step b) and the PSA-serpin complex value and, respectively, the PSAfree/PSA-ACT value from step f) is built.
For a successful method procedure it is essential that the free PSA obtained by the cleavage according to the invention is immunologically reactive. This means that the epitopes recognized by the antibodies will be completely preserved even after the cleavage by amine-containing nucleophilic reagents. An important advantage of the process according to the invention is that for the determination of free and total PSA the same antibodies, i.e. antibodies of the same specificity can be used. The time- and cost-intensive development of antibodies with a different specificity as required in the state of the art processes can thus be avoided. The higher the number of different antibodies used the higher is the risk of unspecific interactions with sample components.
Since in the process according to the invention mostly only two different antibodies are used these interactions can be reduced considerably compared to the state of the art.
Heterogeneous and homogeneous test procedures are appropriate test formats for the process according to the invention. The conventional heterogeneous sandwich assay has proven to be particularly advantageous. Here, the analyte (in our case the PSA antigen and, in the state of the art processes also the PSA-ACT complex) is bound like a sandwich between a binding partner bound to a solid phase and a labeled binding partner there: the antibody). The labeling is detected according to measures known to the expert. Usual labelings are enzymes, luminescent substances, haptens such as digoxigenin, fluorescent and radioactive substances. Plastic tubes, microtiter plates, latex particles or magnetic beads can for example be used as the solid phase. A surface coated with streptavidin or avidin is used preferably. The antibody can be bound directly by adsorption to the solid phase or, preferably, indirectly. In the case of an indirect binding an antibody coupled with biotin binds to the solid phase coated with streptavidin or avidin.
PSA can also be detected by means of a competitive procedure. In this case a solid-phase bound complex is built by two binding partners specific for each other where the binding partner which is not directly bound to the solid phase is labeled. The analyte which isxe2x80x94depending on the test requirementsxe2x80x94an antigen or an antibody dislodges the labeled binding partner according to its concentration from the complex. After the separation of the solid phase from the liquid phase the labeling is detected in one of the phases. For a PSA test with a competitive test procedure the solid-phase bound binding partner would for example be an antibody specific for free PSA. The other binding partner would, then, be labeled free PSA. Afterwards this labeled free PSA is dislodged by the free PSA in the sample depending on the concentration of free PSA.
The test formats and their procedures mentioned as well as the detection of the analytes are only presented as examples for illustration. The methods are known to the expert and need no further explanation here.
In all test formats at least one antibody specifically binding to free PSA but not to complex PSA must be used. The antibody can be monoclonal or polyclonal. The antibody preferred is, however monoclonal. Whole antibodies as well as fragments thereof such as Fab, F (ab)xe2x80x2, F(ab)xe2x80x22 can be used. What is important is the specificity for free PSA which means that the antibody specific for free PSA may only react with uncomplexed PSA. Cross reactivities with complex PSA must not occur at all or only to such a negligible extent that they do not distort the test results. If further antibodies are necessary they can also be used as intact monoclonal or polyclonal antibodies or fragments thereof. The requirements for these further antibodies are that they must recognize free PSA. A cross reaction with complex PSA is, however, not critical.
According to the invention all biological fluids known to the expert can be used as samples. Body fluids such as whole blood, blood serum, blood plasma, sperm or urine are used preferably as samples.
According to the invention nucleophilic amine-containing reagents are used for the cleavage of the PSA-serpin complexes to which belong preferably amino alcohol like e.g. ethanolamine and diethanolamine. Ethanolamine is used particularly preferably. The PSA-ACT complexes are split by adding the nucleophilic amine-containing reagent to any sample containing PSA in a complex form. A reagent concentration of 0.05 to 2 M has proven to be appropriate. The concentration preferably used is 0.1 to 1 M. The preferable pH in the sample is between 9 and 11. The incubation temperature of the thus treated sample containing the nucleophilic amine-containing reagent is not critical. A temperature between 10 and 40xc2x0 C., preferably between 20 and 30xc2x0 C., particularly preferably of 25xc2x0 C. has been proven to be appropriate. The incubation in general takes several hours. Since the free PSA formed by cleavage is stable incubation periods of 24 hours and more are possible for the process according to the invention. Therefore another subject matter of the invention is also a process for the production of free PSA by incubation of a sample containing complex PSA with a nucleophilic amine-containing reagent under the conditions mentioned before. Afterwards the resulting free PSA can for example be used for further diagnostic or scientific structure or function investigations.
A further subject matter of the invention is therefore the use of the free PSA produced according to the process in accordance with the invention for non-immunological investigations like e.g. mass spectrometry.
A further subject matter of the invention is the use of a nucleophilic amine-containing reagent, preferably of an amino alcohol and particularly preferably of ethanolamine for the production of free PSA.
The PSA produced according to the above process can also be used as a standard according to the invention. Such a standard can be used for the establishment of calibration curves in immunoassays for the quantitative detection of PSA.
A further subject matter of the invention is the use of a nucleophilic amine-containing reagent in an immunological process for the quantitative detection of PSA. Ethanolamine is used preferably.
A further subject matter of the invention is a reagent containing at least one nucleophilic amine-containing reagent, preferably ethanolamine for the use in an immunoassay to detect PSA as well as further components known to the expert such as buffers, salts and detergents. The reagent is preferably provided in liquid, aqueous form.